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Today, the Council for Healthcare Regulatory Excellence (CHRE), published the final report of its Strategic review of the Nursing and Midwifery Council (NMC). CHRE is the body that scrutinizes and oversees the work of the nine regulatory bodies that set standards for training and conduct of health professionals*.
The review was commissioned by the Department of Health in January 2012, its terms of reference focussing on whether the leadership, management, organisational structure and resource allocation of the NMC was "correctly aligned to ensure that it could deliver its regulatory functions in the most efficient and effective manner”. Where it was found to be lacking, recommendations were sought as to the changes that could be made to improve the position, in order to enable the NMC to increase capacity and deliver its core functions in an improved manner.
The interim report was delivered on 10 April and the key findings were unequivocal. The malaise at the heart of the NMC was put down to “confusion over its regulatory purpose, lack of clear, consistent strategic direction, unbalanced working relationship and inadequate business systems” including creaking IT infrastructure. There was a concern that on occasion, a sense of “representation” of nurses and midwives persisted in place of the primary remit of the NMC – that of patient protection.
In the final report, there is an acknowledgment that the NMC has already started to implement changes since the inception of the review and delivery of the interim report and praise for dedicated staff. However, that must be small comfort in the reading set alongside the overall expansion of themes identified in the interim report. Historic poor corporate governance is pinpointed as causative of the parlous state of affairs at the regulator, particularly the dysfunctional relationships and communication between the former Chair, Chief Executive and Council. These poor relationships have been found to have negatively impacted on the working environment. A culture of “resigned resilience” has become the norm, with it being observed that staff either leave (31% turnover during 2011 – 12) or accept poor standards as inevitable and normal.
The interim Chief Executive, Jackie Smith, appeared as a guest on Radio 4’s “Today” this morning. In a departure from the politicians who frequently feature on that programme, she was full and frank in accepting the CHRE findings. She said quite simply and sincerely "the report highlights substantial failings. We recognise these and we are sorry”.
The report has been 6 months in the making and in some sense one can imagine the relief at the NMC in hearing the worst: the gathering storm clouds that have been building since before the release of the interim report have finally broken. After the storm, there must be a hope that a brighter and improved future beckons. Now comes the arguably more daunting prospect of implementing the 15 recommendations that have been made by the CHRE review. The NMC is a behemoth. It holds the largest register of any UK regulator, some 670,000 nurses and midwives. It employs over 400 staff. It has 3 hearing venues in London. It is currently hearing 15 cases a day and hopes to go up to 18. Instituting structural and cultural change is an enormous task to achieve on top of keeping the shop open: the day to day work of processing ever rising ftp referrals, up 52% in the last two years and no signs of that trajectory abating, not to mention seeking to reduce the backlog. This set against historic underinvestment in fitness to practise. The rise in registration fees to £120 has already been met with indignation by unions who complain that the cost and benefit of a well regulated nursing profession should not be shouldered by the registrants alone where public protection is in the wider public interest.
The NMC is seeking a new chairman and chief executive. Applications welcome from all but the faint hearted.
*General Chiropractic Council (GCC), General Dental Council (GDC), General Medical Council (GMC), General Optical Council (GOC), General Osteopathic Council (GOsC), General Pharmaceutical Council (GPhC), Health and Care Professions Council (HCPC), Nursing and Midwifery Council (NMC), Pharmaceutical Society of Northern Ireland (PSNI).
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